Read an Excerpt
The Enemy in Your Cupboard
By Mark Phillips Elizabeth Mussin
AuthorHouseCopyright © 2011 Mark Phillips and Elizabeth Mussin, M.D.
All right reserved.
Chapter OneMeet Bob
There once was a boy named Bob. Bob grew up near the west coast of Michigan. He was like most other boys his age. He liked baseball, hockey, and small engines. Bob had an interesting habit. He used the toilet a lot. A lot. At first, he didn't think much about the number of times he went to the bathroom. He figured everyone had to go a dozen times a day. Any boy wouldn't know what was normal, right?
"Hey, Charlie, how often do you blink? How often do you think about girls? How often do you poop?"
See, it's not really something that comes up in conversation. Besides, once he suspected that something was wrong, he certainly wasn't going to tell anyone about it. Hello! What teenage boy wants to have that talk?
The day of his eighteenth birthday, when the wisdom and knowledge of adulthood flows directly into the brains of all children as they become fully grown, Bob accepted the fact that he spent an unhealthy amount of time on the pot. He also noticed that there was blood in what he left behind.
Bob went to the doctor.
The diagnosis was hemorrhoids. That explained the blood. He spent so much time pushing, his butt was bleeding.
Doc Says ...
Hemorrhoids are actually popped blood vessels, like varicose veins of the anus. Imagine a new balloon. When you first begin to fill it with air, it only fills to its original shape and volume. Then bloop! You give it some more pressure and it becomes larger and forms a new shape. Hemorrhoids are normal veins that have stretched to new shapes and sizes, usually from increased pressure from straining when you poop. They can be inside or outside the anus. Hemorrhoids are thin walled and filled with blood, so when they are irritated, they leak bright red blood into your stool, in the toilet, or onto the paper.
Needless to say, Bob was appalled. Old men and pregnant women got hemorrhoids, not healthy young men! The treatment was an unpleasant combination of cream and suppositories and ... yech ... dealing with his rump in an all-too-personal way. Looking back, Bob wished all he had to deal with were some broken blood vessels around his anus.
Unfortunately, his diagnosis only explained the blood, not the excessive amount of stool. He dutifully applied creams, slipped bullet shaped things up inside, and didn't get any relief.
Back to the doctor he went.
He was sent to a new doc with a fancy title: a gastroenterologist. After a few quick upward glances (including one or two involving a camera-on-a-stick) Bob was giving a new disease to learn about: ulcerative colitis.
Doc Says ...
Ulcerative Colitis involves the lining of the colon-the large intestine. The disease begins at the anus and travels upstream. It can be short or go all the way to the junction of the small intestine. When a disease ends with "itis", that means something is inflamed. Colitis means inflammation of the colon. There is redness, swelling, and eroded areas (ulcers) all along the inside of the colon. These raw areas bleed into the colon and irritate it, causing it to spasm. That causes frequent and loose bowel movements.
Relieved he didn't only have hemorrhoids, Bob adhered to a daily regimen of all sorts of pills. Every morning, he popped 5 to 20 mg of a steroid called Prednazone, a sulfur based medicine that only made things smell bad, another suppository, and two different blood pressure meds. Three times a day, he wolfed down prescription strength anti-diarrheal, and other maintenance meds.
Over the years, Bob got to know his colon the way a jockey knows his horse. He knew which foods were going to make him "pay for it" before the night was over. He enjoyed beer, but it always kicked back. Salsa was dangerous, probably because of the heat. Spaghetti was bad because of the acidity of the tomato sauce. When he was being good, he would avoid those foods, but that wasn't always easy.
When he had been bad, he knew he would pay for it, and he always did. When his colon was overpowered by his diet, he was able to give it some help. Under doctor's orders, he would take a little more steroids until things settled down a bit. Once stable, he would back off the dose.
If anyone is interested in another reason avoid steroids, here is one: when you take more and more steroids, you develop what is known in the medical profession as "Moon Face." Your face starts to look like ... well, the moon. (Those medical professionals are quite creative when they name things.) Then when you decide Humpty Dumpty needs to reduce the amount of 'roids you are taking, an interesting thing happens: the chemistry in your body is so out of whack, you tend to act like a total jerk. For years, Bob bounced between being fat faced and pleasant and being lean and really mean.
That's not all that Bob had to look forward to. Steroids, if used for a long time, eventually mess with every body system they can get a grip on. He had heightened chances to come down with osteoporosis, striates (stretch marks), and lymphoma. The worst case scenario was even more grim. In addition to daily discomfort and hours in the john, victims of ulcerative colitis have a one in three chance to get colon cancer.
Sometime in the middle of this hormonal rollercoaster, Bob was lucky enough to land a wife. Her name was Bridget. Being intimately involved with Bob, she was also intimately involved with his digestive issues. Her major role in this story will be apparent later on.
Eventually, his doctor decided that the medicine was not doing its job properly. (This had been Bob's opinion for years.) The doc's solution offered hope, but seemed a bit extreme. He was going to remove Bob's colon. The whole thing. He wasn't even going to have a semi-colon left. His small intestine would remain and have to do all of the work it used to share with its larger brother. Since all the problems Bob had began in the colon, the idea was, if they got rid of it, the issues would go with it. It sounded too good to be true.
Doc Says ...
True ulcerative colitis has a "geographic" starting and ending point, without any skipping around. It does not extend beyond a few centimeters into the ileum (the last section of the small intestine), and never further upstream.
The doctor's idea was right. If Bob's only problem were ulcerative colitis, removing his colon would cure him.
Bob had the surgery. It was supposed to take 3 hours. It took 6. He was supposed to recover in 6 weeks. It took 6 months. His J-pouch got infected and he ended up back in the hospital. The J-pouch was not ready for reconnection when it was supposed to be, so he had to keep his ileostomy bag much longer. (A side note here about Bridget. Being a loving wife, she cleaned and replaced the bag, which, by design, was full of her husband's feces. She had geared herself for 6 weeks of this chore and ended up doing it for 4 ½ months.)
Doc says ...
A J-pouch is formed after the entire large intestine is removed. The end of the ileum (small intestine) is formed into a J with the bottom of the curve connected to the anus. This allows for the normal route of elimination and relieves the patient of the need for a permanent artificial stoma and bag. An ileostomy (stoma and bag) is usually needed temporarily higher up the small intestine to divert stool away from the surgical joining site while it heals. When the pouch is ready to start working, a second surgery removes the ileostomy, closes the hole in the abdominal wall, and sends the feces along to its natural end point.
Finally, his body recovered from the surgery and Bob was ready to enjoy a life free of medicines and fear of unpleasant bowel movements. For nine years, he kept waiting for this new life to begin, but it never did. He kept looking for a time to get off the meds, but he was never healthy enough to do it. He slowly but surely sank into depression. He had tried the most radical treatment for ulcerative colitis there was, and he had not been cured. He was stuck with this forever.
Then Bridget met Carolyn.
Chapter TwoMeet Bridget Meeting Carolyn
It's important to know a little bit about Bridget. She is the second child. Her older sister, Liz, is the responsible one, the schedule keeper, the planner. Liz grew up and became a medical doctor who is more comfortable reading a book than being surrounded by a large group of people.
Just as Liz personifies the stereotypical first born, Bridget is the epitome of a second child. She is extroverted. She is very extroverted. She grew up and became the foreman of a plant in charge of dozens of workers. Everyone knows Bridget. She is the life of every party. There is a scene in Disney's Tarzan, when one of the jungle king's gorilla friends named Terk (played by Rosie O'Donnell) comes through the bushes and sings, "The fun has arrived!" That's Bridget.
Carolyn is the wife of a man who is a good friend of the father of the husband of Bridget's older sister. So, of course, Bridget struck up a conversation with her one day. Somehow, the topic came around to some of Carolyn's dietary discomfort. (How this subject came up in what was essentially a polite discussion of the weather is best left unpublished.) It turned out that Carolyn had been victim of many of the same symptoms as Bob. She had not developed her symptoms until later in life, but her initial treatments had proved fruitless as well.
Finally, she had looked into Celiac Disease. She had wanted to see if she was intolerant of gluten. When she had stopped eating anything with wheat in it, her symptoms had disappeared.
"All of your symptoms stopped?" she asked, almost in a whisper.
"If I eat wheat, I feel it. If I don't, I'm fine."
Bridget's mind whirled. Could this be the answer? Might Bob have Celiac Disease? Were his problems that simple? If that were true, she saw a light at the end of his, ahem, digestive tunnel.
Bridget peppered Carolyn with questions about her disease and how she treated it. What foods had gluten? She was very surprised how many snuck wheat products in there. Twizzlers? Who knew?
Bridget then went to her local medical authority: her older sister, Dr. Liz, M.D. Liz obviously knew Bob's history and thought Bridget's thinking had some validity. It wouldn't take long to figure it out, Liz said. Maybe a week of eating gluten free. If he felt better, the answer was clear. If not, no harm done. The two women got to work listing the foods Bob was allowed to eat.
This is going to be easy, Bridget thought. Now I've got to tell Bob.
After a day or two, Bridget had figured out the best way to approach her husband with her idea.
"Honey," she said. "You remember Carolyn?"
"You mean your sister's husband's dad's friend's wife? Yeah, I remember her."
"Good. Did you know she has Celiac Disease?"
"You know what, I must have missed that detail. What is Celiac Disease?"
"She's can't eat wheat."
"Wheat? That's a bummer. No bread? No cereal? Too bad for her."
"Yes, too bad. Whenever she eats anything with gluten in it, she gets bad cramps and diarrhea.
She had Bob's attention now.
"Say that again?" he said.
She told him Carolyn's symptoms. They sounded an awful lot like his.
"Are you thinking what I'm thinking?" he asked. "That I might have the same thing? That I'm intolerant of wheat?"
"Here's what I'm thinking. You go one week without eating anything with gluten in it. No bread, no beer, no pasta. Liz thinks that if you have the same thing as Carolyn, you'll feel better. If not after a week, you're no worse off."
"I don't know. The colectomy was supposed to cure everything. I don't want to get my hopes up again."
"You don't have to do anything with your hopes. Just stop eating wheat."
Bob thought about it for all of three seconds.
"Let's give it a try," he said.
Three days later, Bob stopped taking his medicine.
Chapter ThreeGoing Gluten-Free
The test to determine if you have Celiac Sprue (the official name of Celiac Disease) is probably one of the easiest you can take. It is certainly the cheapest. You don't have to pay your doctor a dime and you don't have to spend any extra money. All you have to do is stop eating wheat. It really is that simple. After a week (maybe two to be sure), if you do not feel 300% better and your gluteus grossness does not reduce dramatically, your small intestine does not have an issue with gluten. Go have a ham sandwich with processed American cheese on whole wheat toast with Miracle Whip Lite. Then go back to the drawing board.
If you have digestive discomfort and gluten intolerance is your problem, it will only take two or three days for you to notice. Once the core culprit is eliminated from your digestive system, it can get back to working as it was intended. The small intestine can start working on repairing any damage done, and you can get back to living life the way it was intended: far away from the restroom.
However, if your chief complaint is overall fatigue or something other than G.I distress, you are in a slightly different boat. If your symptoms are not related to your rear end, it will be more difficult to determine if removing gluten is an answer, a cure, or a waste of time. You will need to pay close attention to your physical health all throughout the test, and might have to spend two, three or four gluten-free weeks to determine if it has an effect. Notice how you feel before a meal and after, first thing in the morning and just before bedtime. Rate your overall feeling of health and write it down. You can bring this information to your doctor when the test is over.
It would seem to be a sensible thing to test out your gluten intolerance by running out to your local fruit and nut health store and stock up on a week's supply of gluten free bread, crackers, pasta, and sandwich spread. DO NOT DO THIS!! That is what Bridget did, and she is a very sensible person. She, however, got "lucky" and hit the jackpot with Bob's problem. What if Bob had not had any change in his condition? They would have been stuck with a bunch of gluten-less food that tasted ... let's just say "different" for now ... and a grocery bill that was larger than necessary. There will be more on gluten free food later, but for now, just know that if you don't need to eat it, you probably wouldn't want to.
For a week, give up any food that contains wheat. This does not mean bread alone. This also includes cookies, pasta, and a host of other things. You need to get very good at reading the back of food containers. Don't worry that you are going to clog the aisles by standing in everyone's way. There is a growing crowd of people who, for many different reasons, want to know exactly what they are putting into their families' stomachs. Next time you are at your local market, count how many people are standing next to a shelf, just staring at a box. You'd be surprised. Just like mall-walking in the 90s, box-reading is the newest retail craze.
Unlike calorie-, point-, or carb-counters, you don't need any math skills at all. If you see any of the following words in the ingredients list, simply put the box back. That brand is bad for your bum.
The ingredients that will cause you angst and pains and rushes to the john are:
Wheat. This includes: wheat flour, wheat germ, wheat bran, wheat wheat, wheat-arator, wheating, wheeeeee! (okay, the last few are fictional, but if you see the word "wheat" run away—except for Buckwheat. Keep reading.)
Excerpted from The Enemy in Your Cupboard by Mark Phillips Elizabeth Mussin Copyright © 2011 by Mark Phillips and Elizabeth Mussin, M.D.. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.